{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:18:26Z","timestamp":1772119106602,"version":"3.50.1"},"reference-count":29,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Heart, Lung, and Blood Institute of the National Institutes of Health","award":["K01HL175117"],"award-info":[{"award-number":["K01HL175117"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,3]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Black women in early midlife experience disproportionate exposure to stress and elevated cardiovascular risk, including hypertension. Despite this, few stress management interventions are designed with and for this population. This study aims to explore the lived experiences of stress and coping among black women in early midlife with elevated blood pressure to inform the codesign of a culturally relevant, multilevel stress management intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will conduct one-time, semistructured focus groups with black women aged 35\u201350 who have elevated blood pressure, recruited from a large safety-net health system. Data will be analysed using a constructivist grounded theory approach, with inductive theme development supported by line-by-line, focused and theoretical coding. The Social Determinants of Cardiovascular Disease framework will serve as a sensitising guide to multilevel contextual factors rather than a prescriptive coding structure. An artificial intelligence (AI)-assisted analytic component will complement human-led analysis by supporting preliminary theme exploration and enhancing transparency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Approved by the Indiana University Institutional Review Board (Protocol #21785). All participants will provide written informed consent. Findings will be shared via peer-reviewed publications, conference presentations and lay summaries for stakeholders.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-116827","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T14:15:24Z","timestamp":1772115324000},"page":"e116827","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring stress and coping among black women in early midlife with elevated blood pressure in a safety-net health system: a qualitative focus group protocol"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9035-8855","authenticated-orcid":false,"given":"Briana N","family":"Sprague","sequence":"first","affiliation":[{"name":"Divison of General Internal Medicine and Geriatrics; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA"},{"name":"IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexis R","family":"Beverly","sequence":"additional","affiliation":[{"name":"IU Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"2026022606150976000_16.2.e116827.1","doi-asserted-by":"crossref","unstructured":"Williams TR , Erving CL , Frierson W , et al . Facilitating healing for black women experiencing gendered racism and traumatic stress: the moderation of psychosocial resources. Psychiatry and Clinical Psychology [Preprint] 2023. doi:10.1101\/2023.04.17.23288699","DOI":"10.1101\/2023.04.17.23288699"},{"key":"2026022606150976000_16.2.e116827.2","first-page":"222","article-title":"A Qualitative Assessment of Gender- and Race-Related Stress Among Black Women","volume":"3","author":"Tipre","year":"2022","journal-title":"Womens Health Rep (New Rochelle)"},{"key":"2026022606150976000_16.2.e116827.3","first-page":"116","article-title":"Psychologically Resilient, but Physically Vulnerable? Exploring the Psychosocial Determinants of African American Women\u2019s Mental and Physical Health","volume":"7","author":"Erving","year":"2021","journal-title":"Black Mental Health"},{"key":"2026022606150976000_16.2.e116827.4","doi-asserted-by":"publisher","DOI":"10.1177\/1049732310361892"},{"key":"2026022606150976000_16.2.e116827.5","doi-asserted-by":"crossref","DOI":"10.1111\/spc3.12705","article-title":"25 years of psychology research on the \u201cstrong black woman\u201d","volume":"16","author":"Thomas","year":"2022","journal-title":"Social & Personality Psych"},{"key":"2026022606150976000_16.2.e116827.6","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1007\/s11199-020-01170-w","article-title":"In Their Own Words: The Meaning of the Strong Black Woman Schema among Black U.S. College Women","volume":"84","author":"Jones","year":"2021","journal-title":"Sex Roles"},{"key":"2026022606150976000_16.2.e116827.7","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1037\/amp0001304","article-title":"I am not (your) superwoman, Black girl magic, or beautiful struggle: Rethinking the resilience of Black women and girls","volume":"79","author":"Bentley-Edwards","year":"2024","journal-title":"Am Psychol"},{"key":"2026022606150976000_16.2.e116827.8","doi-asserted-by":"crossref","first-page":"3142","DOI":"10.1007\/s40615-024-02119-5","article-title":"Resilience in Black Women: Lifeline or Double-Edged Sword?","volume":"12","author":"Perry","year":"2025","journal-title":"J Racial Ethn Health Disparities"},{"key":"2026022606150976000_16.2.e116827.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccl.2016.12.004"},{"key":"2026022606150976000_16.2.e116827.10","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1037\/abn0000818","article-title":"Intersections of oppression: Examining the interactive effect of racial discrimination and neighborhood poverty on PTSD symptoms in Black women","volume":"132","author":"Ravi","year":"2023","journal-title":"J Psychopathol Clin Sci"},{"key":"2026022606150976000_16.2.e116827.11","doi-asserted-by":"crossref","DOI":"10.1093\/sleep\/zsaf023","article-title":"Effects of contextual stress on Black mothers\u2019 self-reported and actigraph-estimated postpartum sleep","volume":"48","author":"Hart","year":"2025","journal-title":"Sleep"},{"key":"2026022606150976000_16.2.e116827.12","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.119.14492"},{"key":"2026022606150976000_16.2.e116827.13","doi-asserted-by":"crossref","first-page":"116699","DOI":"10.1016\/j.socscimed.2024.116699","article-title":"Financial responsibility, financial context, and ambulatory blood pressure in early middle-aged African-American women","volume":"345","author":"Lewis","year":"2024","journal-title":"Soc Sci Med"},{"key":"2026022606150976000_16.2.e116827.14","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1097\/JCN.0000000000000671","article-title":"The Effect of Contextualized Racial and Gendered Stressors, Social Support, and Depression on Hypertension Illness Perceptions and Hypertension Medication Adherence in Young African American Women With Hypertension","volume":"35","author":"Spikes","year":"2020","journal-title":"J Cardiovasc Nurs"},{"key":"2026022606150976000_16.2.e116827.15","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-07073-0"},{"key":"2026022606150976000_16.2.e116827.16","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1001\/jamacardio.2022.2345","article-title":"Age at Diagnosis of Hypertension by Race and Ethnicity in the US From 2011 to 2020","volume":"7","author":"Huang","year":"2022","journal-title":"JAMA Cardiol"},{"key":"2026022606150976000_16.2.e116827.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmjph-2024-001993","article-title":"Racial disparities in hypertension subtype prevalence over the lifecourse: evidence of accelerated arterial ageing in a population representative cross-sectional study","volume":"3","author":"Reeves","year":"2025","journal-title":"BMJ Public Health"},{"key":"2026022606150976000_16.2.e116827.18","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1038\/s41569-024-01024-y","article-title":"Stress and cardiovascular disease: an update","volume":"21","author":"Vaccarino","year":"2024","journal-title":"Nat Rev Cardiol"},{"key":"2026022606150976000_16.2.e116827.19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/17455065211009751","article-title":"Stress interventions and hypertension in Black women","volume":"17","author":"Kalinowski","year":"2021","journal-title":"Womens Health (Lond Engl)"},{"key":"2026022606150976000_16.2.e116827.20","doi-asserted-by":"crossref","first-page":"e260","DOI":"10.1161\/CIR.0000000000001096","article-title":"Leveraging Implementation Science for Cardiovascular Health Equity: A Scientific Statement From the American Heart Association","volume":"146","author":"Moise","year":"2022","journal-title":"Circulation"},{"key":"2026022606150976000_16.2.e116827.21","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.121.319811"},{"key":"2026022606150976000_16.2.e116827.22","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.36207","article-title":"Neighborhood factors, individual stressors, and cardiovascular health among Black and White adults in the US: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study","volume":"6","author":"Hines","year":"2023","journal-title":"JAMA Open Network"},{"key":"2026022606150976000_16.2.e116827.23","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1161\/HYPERTENSIONAHA.124.23721","article-title":"Caregiving and Hypertension in Younger Black Women: The Jackson Heart Study","volume":"82","author":"Arabadjian","year":"2025","journal-title":"Hypertension"},{"key":"2026022606150976000_16.2.e116827.24","doi-asserted-by":"crossref","unstructured":"Charmaz K . Constructing Grounded Theory. Sage College Publishing, 2024.","DOI":"10.4135\/9781036232764.n4"},{"key":"2026022606150976000_16.2.e116827.25","doi-asserted-by":"crossref","unstructured":"Zhang H , Wu C , Xie J , et al . n.d. Harnessing the power of AI in qualitative research: Exploring, using and redesigning ChatGPT Computers in Human Behavior: Artificial Humans 2025;4:100144. doi:10.1016\/j.chbah.2025.100144","DOI":"10.1016\/j.chbah.2025.100144"},{"key":"2026022606150976000_16.2.e116827.26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/16094069251383739","article-title":"AI as a Co-researcher in the Qualitative Research Workflow: Transforming Human-AI Collaboration","volume":"24","author":"Costa","year":"2025","journal-title":"Int J Qual Methods"},{"key":"2026022606150976000_16.2.e116827.27","unstructured":"Wei J , Wang X , Schuurmans D , et al . Chain-of-thought prompting elicits reasoning in large language models. 2023;arXiv."},{"key":"2026022606150976000_16.2.e116827.28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/16094069251322346","article-title":"\u201cConversing\u201d With Qualitative Data: Enhancing Qualitative Research Through Large Language Models (LLMs)","volume":"24","author":"Hayes","year":"2025","journal-title":"Int J Qual Methods"},{"key":"2026022606150976000_16.2.e116827.29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/16094069251321251","article-title":"Researcher Positionality: Ways to Include it in a Qualitative Research Design","volume":"24","author":"Goundar","year":"2025","journal-title":"Int J Qual Methods"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-116827","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T14:15:29Z","timestamp":1772115329000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-116827"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,26]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjopen-2026-116827"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-116827","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}